Cotton attempted to define and grade complications after an endoscopy procedure. The author is from Charleston, South Carolina.
|
Bad Outcome |
Description |
|---|---|
|
primary failure |
The aim of the procedure was not completed |
|
secondary failure |
Relapse of the original problem (failure to resolve) |
|
adverse sequelae |
Inevitable concomitants of the procedure |
|
unrelated problems |
Aggravation of an existing problem or onset of new problem not caused by the procedure or addressed by it (no causal link) |
|
focal complications |
Problem clearly related to the procedure, occurring in organs traversed or treated, with symptoms appearing within 30 days |
|
nonspecific complications |
Problems occurring in organs which have not been treated or traversed, with symptoms appearing within 3 days |
Exclusions for grading severity:
(1) not attributable to the procedure
(2) resolves without direct physician attention
|
Resolution |
Severity |
|---|---|
|
resolves as outpatient (does not require inpatient admission) |
minimal |
|
does not prolong planned stay |
minimal |
|
requires a hospital length of stay <= 3 nights |
mild |
|
requires a hospital length of stay 4 – 10 nights |
moderate |
|
requires a hospital length of stay > 10 nights |
severe |
|
requires ICU admission |
severe |
|
requires surgical intervention |
severe |
|
death attributable to the procedure (within 30 days; under continued inpatient treatment for the complication) |
fatal |
Additional determinants mentioned but not included in severity scheme:
(1) need for transfusion
(2) percutaneous or endoscopic intervention
(3) residual permanent disability
(4) total length of stay
where:
• The use of hospital length of stay is a somewhat pragmatic measure. However, with the tendency to treat people as outpatients this may be an insensitive measure for mild or moderate complications.
• The need for transfusion can probably be subtended to physician intervention and hospital length of stay.
• I would think a repeat percutaneous or endoscopic intervention could be classified as mild (minor) or moderate severity.
• Permanent disability can be graded as minimal, mild, moderate and severe.
• Total length of stay could include time required for recovery at home. This is not defined but here are some suggested cutoffs: <= 1 week mild, 1 – 4 weeks moderate, > 1 month severe.
Purpose: To determine the severity of an adverse medical event caused by an endoscopy procedure using the scheme of Cotton.
Objective: adverse effects, prevention
ICD-10: Y83.8,
